Circulating endothelial cells hit the mark in primary central nervous system vasculitis

Jan 2 2013

By Lucy Piper, Senior medwireNews Reporter

Circulating endothelial cells (CECs) may be a promising, non-invasive means of diagnosing and monitoring primary central nervous system vasculitis (PCNSV), researchers report.

They found that levels of the cells were elevated in patients with biopsy-proven and suspected active PCNSV.

A decrease in CEC levels after successful immunosuppressive treatment also suggests that they may be useful markers of disease activity and treatment, notes the team in the Journal of Neurology Neurosurgery and Psychiatry.

"Due to the poor prognosis of untreated PCNSV on the one hand and the serious side effects of aggressive immunosuppressive treatment on the other, diagnostic criteria and reliable markers are important," say the researchers.

"To date, brain biopsy is the only means to obtain a definite diagnosis, but its sensitivity is only about 50-75%. Thus, more and better diagnostic criteria are required."

Milani Deb, from Hannover Medical School in Germany, and colleagues assessed CEC levels in 18 patients, of whom three had biopsy-proven PCNSV and 15 had clinical, cerebrospinal fluid, and imaging data highly suggestive of PCNSV. Of the 15 patients with suspected active PCNSV, three had CEC assessment performed after initiation of successful immunosuppressive therapy.

Immunomagnetic isolation of CECs from peripheral blood showed that levels were extremely elevated in this group of patients, at a median of more than 400 cells/mL in the three patients with confirmed PCNSV and 346 cells/mL in the remaining 12 patients with highly suspected PCNSV who had not received immunosuppressive therapy.

This was significantly higher than in a comparison group of 16 healthy volunteers and 123 individuals with cerebrovascular risk factors and/or ischemic stroke, for whom median levels were 8 cells/mL and between 8 and 68 cells/mL, respectively.

In the three patients who were assessed after immunosuppressive therapy, the median CEC level was 12 cells/mL, ranging from 0 to 52 cells/mL. This was significantly lower than in the other PCNSV patients, but not significantly different from that of the healthy or disease control groups.

The researchers acknowledge the limitations of their study, including the small number of patients with proven PCNSV and inconsistencies in the diagnostic work-up of the patients, but say their findings "encourage further studies including larger numbers of patients and standardised diagnostic procedures to assess the sensitivity and specificity of this method for diagnosing PCNSV."

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